食管癌调强放疗累及野照射的同期对照研究  

Concurrent control study of involved field intensity modulated radiotherapy in patients with esophageal carcinoma

作　　者：李多杰[1] 李红伟[1] 崔珍[1] 何斌[1] 刘静景[1] 蔡汉飞[1] 段诗苗[1] 江浩[1] 

机构地区：[1]蚌埠医学院第一附属医院放疗科,233000

出　　处：《实用医学杂志》2016年第11期1799-1802,共4页The Journal of Practical Medicine

基　　金：安徽省卫生厅"十二五"临床重点专科建设基金资助项目(编号:01Z33)

摘　　要：目的:探讨不同临床靶体积对食管癌5野调强放射治疗(IMRT)疗效及失败模式的影响,验证累及野照射(IFI)的可行性和最佳适应证。方法:选择2012年1月至2014年6月我院收治行根治性IMRT放疗的食管癌患者共88例进行同期对照研究,44例进入IFI组,44例进入预防性淋巴结照射组(ENI)。结果:IFI组和ENI组1、2年的生存率分别为75.0%、45.5%和70.5%、43.2%(P>0.05)。IFI组和ENI组局部失败率为27.3%和22.7%,远处转移失败率分别为22.7%和18.2%,野外区域失败率分别为11.4%和4.5%,两者比较差异无统计学意义(P>0.05)。亚组分析提示对于原发病灶位于胸上段或临床Ⅰ期者,IFI组野外区域失败有增加趋势。ENI组肺V_5、V_(20)、V_(30)及肺平均受量等指标均大于IFI组,其中V_5和肺平均剂量比较差异有统计学意义。结论:IFI组在生存率、局部控制率方面和ENI组基本相似,但对于原发病灶位于胸上段或临床Ⅰ期者,应谨慎选择IFI。Objective To explore the treatment effect and failure patterns associated with different clinical target volume on patients with esophageal carcinoma treated with 5-filed intensity modulated radiotherapy （IMRT）, and to determine whether involved field in＇adiation（IFI） is practicable in these patients. Methods A total of 88 patients with esophageal carcinoma between January 2012 to June 2014 underwent IMRT in our hospital, were divided into IFI group and elective nodal irradiation（ENI） group according to the CTV range for a concurrent control study. Results One-year and two-year smwival rate in IFI group and ENI group were 75.0%, 45.5% and 70.5%, 43.2% respectively （P 〉 0.05）. Local failure rate in IFI and ENI groups was 27.3% and 22.7% respectively, distant metastasis failure rates 22.7% and 18.2% respectively and regional failure rate outside the radiation field 1 1.4% and 4.5%, which showed no statistical difference （P 〉 0.05）. Subgroup analysis indicated failure outside the radiation field tended to increase for primary lesion located in the up thoracic or clinical stage I in IFI group. The volume dose histogram of lung V5, V20, V30 and mean lung dose of ENI group were greater than that of IFI group, while V5 of lung and the mean lung dose had statistical difference. Conclusions The survival rate and local control rate have no significant differencein IFI group and ENI group, so IFI is feasible for some esophageal carcinoma, but it should be cautious to choose IFI for those primary lesion located in the up thoracie or clinical stage I .

关 键 词：食管肿瘤 调强放射疗法 累及野照射 失败模式 

分 类 号：R735.1[医药卫生—肿瘤] R730.55[医药卫生—临床医学]